Transient ischaemic attack

A transient ischaemic attack (TIA) should be suspected in anyone who presents with sudden-onset, focal neurological deficit that resolves spontaneously and cannot be explained by another condition such as hypoglycaemia.

If you see the patient while they are having ongoing neurological symptoms or soon after, use the National Institutes of Health Stroke Scale (NIHSS) to help identify the need for urgent treatment (thrombolysis). Admit anyone with suspected stroke directly to a hyperacute (or acute, depending on availability) stroke unit within 4 hours of presentation.

Following your initial assessment, give a loading dose of aspirin to anyone with suspected TIA and refer the patient immediately for specialist assessment to be seen within 24 hours of onset of symptoms.

The risk of recurrent stroke is high in the first 7 days following a TIA. Start secondary prevention therapy immediately once the diagnosis of TIA is confirmed.

A TIA is a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction.[1]Easton JD, Saver JL, Albers GW, et al. Definition and evaluation of transient ischemic attack. Stroke. 2009 Jun;40(6):2276-93. https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.108.192218 http://www.ncbi.nlm.nih.gov/pubmed/19423857?tool=bestpractice.com A TIA has a sudden onset and may last anything from a few minutes to 24 hours. Most patients with TIA usually have complete resolution of symptoms and signs within 1 hour.[2]British Columbia Ministry of Health. Stroke and transient ischemic attack: acute and long-term management. April 2015 [internet publication]. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/stroke-tia The definitions of TIA and ischaemic stroke are now 'tissue-based' rather than defined by the duration of neurological dysfunction: there is no ischaemic lesion visible on brain imaging in a patient with TIA. An ischaemic brain lesion on brain imaging, even if a patient's episode of focal neurological dysfunction rapidly resolves, signifies an ischaemic stroke.[3]Amarenco P. Transient ischemic attack. N Engl J Med. 2020 May 14;382(20):1933-41. http://www.ncbi.nlm.nih.gov/pubmed/32402163?tool=bestpractice.com See Ischaemic stroke and Haemorrhagic stroke.